Department of Gastroenterology and Rheumatology, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Int J Clin Oncol. 2011 Aug;16(4):387-94. doi: 10.1007/s10147-011-0197-3. Epub 2011 Feb 18.
This study evaluates the feasibility of chemosensitivity testing by use of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) samples and determines the optimum cut-off value for gemcitabine.
Thirty-four consecutive patients with unresectable pancreatic cancer were enrolled. Chemosensitivity (treated/control ratio: T/C ratio) was calculated as the quantity of adenosine triphosphate for a tumor treated with gemcitabine as a percentage of that for the control. To identify the cut-off value sufficient to predict 180 days of progression-free survival (PFS), the receiver operating characteristic curve and the corresponding area under the curve (AUC) were calculated.
The success of this assay was 88.2% (30/34); therefore, 30 patients were assessable and included in the population of analyzable patients.. The response was 6.7%. Median PFS was 96 days and median overall survival was 241 days, respectively. The cut-off value was determined as 74% (AUC, 0.745; p = 0.053; 95% CI 0.485-1.005). According to this cut-off value, we predicted 180 days PFS with a sensitivity and specificity of 71.4 and 91.3%, respectively. When patients were divided into two groups at T/C ratio 74%, a significant difference was found in PFS (median 77 vs. 205 days, p = 0.0036). Moreover, T/C ratio < 74% and decrease of CA19-9 were significant and independent prognostic factors by multivariate analysis.
Chemosensitivity testing by use of EUS-FNA samples in patients with unresectable pancreatic cancer is feasible. This definition emphasizes the possibility of selecting patients for whom favorable results from gemcitabine treatment can be expected.
本研究通过内镜超声引导下细针抽吸术（EUS-FNA）样本评估化疗药敏试验的可行性，并确定吉西他滨的最佳临界值。
连续纳入 34 例不可切除的胰腺癌患者。通过将吉西他滨处理肿瘤的三磷酸腺苷量与对照的量进行比较，计算化疗敏感性（治疗/对照比：T/C 比）。为了确定足以预测无进展生存期（PFS）180 天的临界值，计算了受试者工作特征曲线及其对应的曲线下面积（AUC）。
该检测的成功率为 88.2%（30/34）；因此，30 例患者成功，可进行评估并纳入可分析患者人群。该研究的有效率为 6.7%。中位 PFS 为 96 天，中位总生存期为 241 天。临界值确定为 74%（AUC 为 0.745；p=0.053；95%CI 为 0.485-1.005）。根据该临界值，我们预测 180 天 PFS 的敏感性和特异性分别为 71.4%和 91.3%。当患者根据 T/C 比分为 74%两组时，PFS 存在显著差异（中位数分别为 77 天和 205 天，p=0.0036）。此外，T/C 比<74%和 CA19-9 下降是多变量分析中显著的独立预后因素。
使用 EUS-FNA 样本对不可切除的胰腺癌患者进行化疗药敏试验是可行的。这一定义强调了选择可能从吉西他滨治疗中获得有利结果的患者的可能性。
